By John M. de Castro, Ph.D.
“They were able to have a sense of personal control over their migraines. It really makes us wonder if an intervention like meditation can change the way people interpret their pain.” – Rebecca Erwin Wells
Headaches are the most common disorders of the nervous system. It has been estimated that 47% of the adult population have a headache at least once during the last year. The most common type of headache is the tension headache with 80 to 90 percent of the population suffering from tension headaches at least some time in their lives. The second most common type of headache is the migraine headache. Around 16 to 17 percent of the population complains of migraines. It is the 8th most disabling illness in the world with more than 90% of sufferers unable to work or function normally during their migraine. American employers lose more than $13 billion each year as a result of 113 million lost work days due to migraine.
There are a wide variety of drugs that are prescribed for chronic headache pain with varying success. Most tension headaches can be helped by taking pain relievers such as aspirin, naproxen, acetaminophen, or ibuprofen. A number of medications can help treat and prevent migraines and tension headaches, including ergotamine, blood pressure drugs such as propranolol, verapamil, antidepressants, antiseizure drugs, and muscle relaxants. Drugs, however, can have some problematic side effects particularly when used regularly and are ineffective for many sufferers. So, almost all practitioners consider lifestyle changes that help control stress and promote regular exercise to be an important part of headache treatment and prevention. Avoiding situations that trigger headaches is also vital.
Mindfulness training has been shown to be an effective treatment for headache pain. Some of the effects of mindfulness practices are to alter thought processes, changing what is thought about. In terms of pain, mindfulness training, by focusing attention on the present moment has been shown to reduce worry and catastrophizing. Pain is increased by worry about the pain and the expectation of greater pain in the future. So, reducing worry and catastrophizing can reduce headache pain. In addition, mindfulness improves self-efficacy, the belief that the individual can adapt to and handle headache pain. In addition, mindfulness training also has been shown to alter not only what is thought, but also how thoughts are processed. Central to this cognitive change is mindfulness and acceptance. By mindfully viewing pain as a present moment experience it can be experienced just as it is and by accepting it, the individual stops fighting against the pain which can amplify the pain.
It is not known whether it is the changes in the what or how, or both, of thoughts that is responsible for mindfulness training’s efficacy in treating headache pain. In today’s Research News article “The mediating role of pain acceptance during mindfulness-based cognitive therapy for headache.” See:
or see below
Day and Thorn investigate this question. They randomly assigned headache patients to receive either 8-weeks of Mindfulness Based Cognitive Therapy (MBCT) or treatment as usual as a wait-list control condition. Before and again after treatment measurements were obtained of pain, pain acceptance, pain catastrophizing, and pain self-efficacy.
They found, as has previously been shown, that the MBCT training significantly reduced the level of pain and pain catastrophizing, and increased the levels of pain self-efficacy and pain acceptance. Day and Thorn then went on to use a sophisticated statistical technique to assess whether the change in pain produced by mindfulness training was due to the changes in the what or how about thinking. They found that only the how aspect of thought, pain acceptance, significantly mediated the effect. Neither of the what aspects of thought, pain catastrophizing nor pain self-efficacy, were significantly related to the mindfulness training effects on pain.
These results are very interesting and potentially important. They suggest that mindfulness training reduces headache pain by altering how pain is thought about, increasing acceptance of the pain. Acceptance is defined as the “conscious willingness to stay in direct contact with experience.” This may operate by reducing the individual’s attempts to counteract the pain. Since, fighting against the pain can actually increase the level of pain, accepting the pain interferes with this amplifying process, thus lowering the pain level experienced. It is interesting that neither the pain catastrophizing nor pain self-efficacy were significant mediators as they have long been thought to be important mechanisms of mindfulness’ effectiveness for pain management. But, it is clear that how pain is thought about, in particular, the acceptance of pain, is the key.
So, reduce pain by accepting it mindfully.
“Awareness transforms emotional pain just as it transforms the pain that we attribute more to the domain of body sensations. When we are immersed in emotional pain, if we pay close attention, we will notice that there is always an overlay of thoughts and a plethora of different feelings about the pain we are in, so here too the entire constellation of what we think of as emotional pain can be welcomed in and held in awareness.” – Jon Kabat-Zinn
CMCS – Center for Mindfulness and Contemplative Studies
Study Summary
Day MA, Thorn BE. The mediating role of pain acceptance during mindfulness-based cognitive therapy for headache. Complement Ther Med. 2016 Apr;25:51-4. doi: 10.1016/j.ctim.2016.01.002. Epub 2016 Jan 13.
Highlights
- Pain acceptance was a significant mediator of the MBCT-pain interference relation.
- Specifically, activity engagement emerged as the critical component of acceptance.
- Pain catastrophizing and self-efficacy did not meet criteria for mediation.
- This is the first study to show acceptance is a key mediator of MBCT for headache.
Abstract
Objectives: This study aimed to determine if mindfulness-based cognitive therapy (MBCT) engenders improvement in headache outcomes via the mechanisms specified by theory: (1) change in psychological process, (i.e., pain acceptance); and concurrently (2) change in cognitive content, (i.e., pain catastrophizing; headache management self-efficacy).
Design: A secondary analysis of a randomized controlled trial comparing MBCT to a medical treatment as usual, delayed treatment (DT) control was conducted. Participants were individuals with headache pain who completed MBCT or DT (N = 24) at the Kilgo Headache Clinic or psychology clinic. Standardized measures of the primary outcome (pain interference) and proposed mediators were administered at pre- and post-treatment; change scores were calculated. Bootstrap mediation models were conducted.
Results: Pain acceptance emerged as a significant mediator of the group-interference relation (p < .05). Mediation models examining acceptance subscales showed nuances in this effect, with activity engagement emerging as a significant mediator (p < .05), but pain willingness not meeting criteria for mediation due to a non-significant pathway from the mediator to outcome. Criteria for mediation was also not met for the catastrophizing or self-efficacy models as neither of these variables significantly predicted pain interference.
Conclusions: Pain acceptance, and specifically engagement in valued activities despite pain, may be a key mechanism underlying improvement in pain outcome during a MBCT for headache pain intervention. The theorized mediating role of cognitive content factors was not supported in this preliminary study. A large, definitive trial is warranted to replicate and extend the findings in order to streamline and optimize MBCT for headache.